老年抑郁症患者内隐情绪调节的神经机制及脑可塑性研究

Clinical practice suggests that the implicit emotion regulation disorder maybe important for the development of late-life depression. However, there is still a lack of experimental research on whether there is implicit emotion regulation deficit and its neural mechanism in late-life depression. By using ERP, our previous study found that both geriatric depressed and young adult depressed patients showed early-staged automatic information processing impairment. However, regarding to the inhibitory control processing, a basic aspects of emotion regulation, different damage modes were shown across the patients groups of two age-range. Whether the brain information processing and control processing effect the implicit emotional regulation abnormally in the depressed patients and the neural mechanism remain unclear. The present study intends to include the elderly and young adult patients with depression and their age-matched groups, using the implicit emotion regulation questionnaire, behavioral measurement, ERP and fMRI, to explore the early emotion recognition and implicit emotion regulation within two categories (implicit control emotion regulation and implicit automatic emotion). The patterns of behavior and brain electrical time course activity, brain regions localization and network characteristics will be discussed, as well as the depression × aging interaction effects in these physiological indexes. Meanwhile, the influence mechanism of neural modulation therapy and drug therapy on the plasticity of implicit emotion regulation will be dynamically observed by comparison before and after treatment. The above study would deepen our understanding in the pathogenesis of late-life depression and optimize the clinical diagnosis and treatment strategies.

临床实践提示内隐情绪调节障碍可能是老年抑郁症发病的重要原因，然而关于老年抑郁症是否存在内隐情绪调节缺陷及其神经机制的实验研究目前几近空白。我们前期的研究发现老年抑郁和青年抑郁都存在早期信息自动加工异常，而在情绪调节的重要环节——抑制控制加工却存在不同损害模式，这种大脑自动加工及抑制控制加工异常如何影响患者的内隐情绪调节的神经机制目前尚未明了。本研究拟以老年抑郁、青年抑郁患者及相应年龄段对照组为研究对象，采用内隐情绪调节问卷、行为学、ERP及多模态MRI技术，探讨内隐情绪识别及内隐情绪调节（内隐自动情绪调节与内隐控制情绪调节）的行为模式、脑电活动时间进程、大脑神经元集群活动环路与网络特征，明确抑郁和老龄化两个变量在上述生理指标的交互作用机制；并通过治疗前后对比，动态观察神经调控（rTMS）与药物治疗对患者内隐情绪调节可塑性的影响机制。从而深化人们对老年抑郁症发病的认识，优化临床诊疗决策。

课题组围绕老龄健康人群和抑郁症、焦虑症的内隐情绪调节障碍，从临床特征入手，开展量表、行为学、事件相关电位、近红外光脑功能成像、功能磁共振成像等技术，系统探讨了内隐认知重评、内隐表达抑制、共情能力老龄化问题，以及抑郁症、焦虑障碍、帕金森病的内隐情绪调节异常的脑机制，得到了一些新发现、新结论。研究揭示了老龄化和抑郁焦虑患者内隐情绪调节的脑加工时间进程特征、脑区定位及特异性神经环路损害。研究发现，发现抑郁症患者内隐认知重评能力受损，表现为左侧DLPFC和左侧OFC区激活较低；广泛性焦虑患者存在内隐认知重评异常，表现为左侧DLPFC、左侧OFC脑激活模式和健康人呈现相反趋势；抑郁症和焦虑障碍在DLPFC、OFC区存在不同的激活模式。为明确抑郁症和焦虑障碍的病理生理及心理生理机制提供了进一步证据，相关脑影像指标可能成为有应用潜质的临床鉴别生物学指标。研究采用精准导航下经颅磁刺激（TMS）对抑郁症和焦虑障碍患者开展了创新靶点（DLPFC+DMPFC双靶点方案）治疗方案，收到良好疗效。.另外，本课题还针对课题实施过程中发现的医患沟通中共情问题，而开展了医学生共情能力培养及其神经机制研究。在医学职业发展的很长一段时间内，医学专业人员普遍面临着与专业技能提升不相匹配的较低水平共情能力。医学专业硕士研究生对医疗情景的图片刺激比非医疗情景表现出更高的共情敏感性，表现为认知共情和情绪共情在疼痛图片上的得分更高；情景模拟教学可以提高临床专业硕士的共情能力，其共情能力改变可以引起脑电变化，这增加了共情可塑性生理机制的有利证据。